New CAR T-Cell therapy drug in lupus renaissance

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Feb 2024: Several new drugs and promising therapies, such as chimeric antigen receptor T-cell therapy, have ushered in a “renaissance” for lupus, according to a speaker at the symposium Basic and Clinical Immunology for the Busy Clinician.

According to Emily Littlejohn, DO, MPH, of the Cleveland Clinic, monoclonal antibodies and interferons are two additional potential treatments for systemic lupus erythematosus that have emerged since 2020.

“2020 is what many of us consider the lupus renaissance,” Littlejohn told attendees during the hybrid meeting. “This is a time where, finally, we had many drugs entering the armamentarium very quickly.”

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According to Littlejohn, there have been a lot of exciting new treatments for SLE since the quick approvals of belimumab (Benlysta, GSK), voclosporin (Lupkynis, Aurinia), and anifrolumab (Saphnelo, AstraZeneca). CAR T-cell therapy might be the most exciting of these.

“This is used in the oncology world—we have seen it in [B-cell acute lymphoblastic leukemia], [B-cell non-Hodgkin’s lymphoma] and mantel cell lymphoma,” Littlejohn said. “The question is: What about in our diseases?”

Littlejohn stated that all patients who participated in a German study that enrolled five patients with multi-organ involvement were able to achieve a state in which nephritis ceased. Littlejohn added that the results provide hope, but the therapy is not risk-free.

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“There is a huge risk of cytokine release syndrome — ICANS in particular — which is very scary,” she said.

“I think there is a lot of promise in this space, just considering these five patients [treated with CAR-T cell therapy] and how well they did,” she added.

Alternatives to CAR T-cell therapy are in development. These include litifilimab (BIIB059, Biogen), interferon—kinoid, obinutuzumab (Gazyva, Genentech) and iberdomide (Bristol Myers Squibb).

Interferon–kinoid failed to meet endpoints in important trials, and its future is “uncertain,” Littlejohn said.

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“Litifilimab was initially studied in cutaneous lupus patients, a total of 132,” Littlejohn said. “What they found was that it met primary endpoints with a decrease in skin CLASI score at week 16.”

Additionally, the drug was successful in reducing the number of joints in active disease, according to Littlejohn said.

Finally, obinutuzumab has met its primary endpoint in patients with lupus nephritis, Littlejohn said.

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